| Wellness Enhancement Center Of Idaho Inc. | |
|
1111 W Ironwood Dr Ste B Coeur D Alene ID 83814-2604 | |
| (208) 664-1594 | |
| (208) 664-5867 |
| Full Name | Wellness Enhancement Center Of Idaho Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1111 W Ironwood Dr Ste B, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Robert Keith Wyatt (PRESIDENT) |
| Authorized Official Contact | 2085036298 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellness Enhancement Center Of Idaho Inc. 1111 W Ironwood Dr Ste B Coeur D Alene ID 83814-2604 Ph: (208) 664-1594 | Wellness Enhancement Center Of Idaho Inc. 1111 W Ironwood Dr Ste B Coeur D Alene ID 83814-2604 Ph: (208) 664-1594 |
| NPI Number | 1417370990 |
|---|---|
| Provider Enumeration Date | 02/04/2014 |
| Last Update Date | 03/10/2020 |
| Certification Date | 03/10/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417370990 | NPI | - | NPPES |
| 807823900 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MHC-421 (Idaho) | Primary |
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